title: Longitudinal hemodiafilter performance in modeled continuous renal replacement therapy.
abstract: OBJECTIVE
  With advanced anticoagulation, many institutions operate continuous renal replacement therapy (CRRT) circuits longer than manufacturers' recommendations. This extended use may change hemodiafilter performance and clearance properties. However, hemodiafilter performance over time has not been assessed. We investigated solute clearance over time in modeled CRRT.
  
  
  METHODS
  In vitro continuous hemofiltration (CH) and continuous hemodialysis (CD) were operated for 48 h using AN69 polyacrylonitrile, cellulose triacetate, F70 polysulfone, and Optiflux F160NR polysulfone hemodiafilters with citrated bovine blood. Urea, creatinine, gentamicin, vancomycin, and albumin clearances were assessed in CH (ultrafiltration rates = 1 and 3 l/h). Clearances of urea, creatinine, gentamicin, and albumin, were assessed in CD with dialysate flow rate of 2 l/h.
  
  
  RESULTS
  Solute CH clearances were significantly higher at 3 l/h. Only creatinine and gentamicin clearances were affected by time. Creatinine CD clearance significantly declined at 48 h for all hemodiafilters, especially polysulfone hemodiafilters.
  
  
  CONCLUSIONS
  CRRT duration affects solute transmembrane clearance. Clinicians should consider hemodiafilter age when assessing hemodialysis dose or drug clearance.
authors.affiliation: Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Mich., USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Pasko
authors.forename: Mariann D
authors.initials: MD
authors.lastname: Churchwell
authors.forename: Noha N
authors.initials: NN
authors.lastname: Salama
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Mueller
mesh_terms: D000327:Adsorption; D000818:Animals; D001672:Biocompatible Materials / Q000737:chemistry / Q000378:metabolism*; D001774:Blood Chemical Analysis / Q000379:methods*; D002417:Cattle; D003404:Creatinine / Q000378:metabolism; D015314:Dialysis Solutions; D005839:Gentamicins / Q000378:metabolism; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007700:Kinetics; D008567:Membranes, Artificial; D011108:Polymers / Q000737:chemistry / Q000378:metabolism*; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D012710:Serum Albumin, Bovine / Q000378:metabolism; D013997:Time Factors; D014508:Urea / Q000378:metabolism; D014640:Vancomycin / Q000378:metabolism
chemical_list: D001672:Biocompatible Materials; D015314:Dialysis Solutions; D005839:Gentamicins; D008567:Membranes, Artificial; D011108:Polymers; D012710:Serum Albumin, Bovine; D014640:Vancomycin; D014508:Urea; D003404:Creatinine